Lots of nursing students have a difficult time remembering the difference between Nephrosis and Nephritis. They sound the same, they both involve the kidneys, and even the signs and symptoms can be really similar. To top it all off, the possible causes of each condition seem a little bit fuzzy if you’re reading it straight out of the textbook. Add it all altogether, and you’ve got some tricky NCLEX-style questions on the horizon!
The good news is that as a safe, effective, beginning nurse, you’re not expected to be able to diagnose these conditions. After all, medical diagnosis is outside of the nurse’s scope of practice anyway! So that makes it easier to narrow down the key pieces of information that you need to know about nephrosis and nephritis so that you can recognize them on an exam or case study, and know what nursing actions should be taken.
(By the way, it’s always a good idea to brush up on your A&P whenever you’re about to study the pathophysiology of an unfamiliar disorder. So if you’re a little rusty on the nitty gritty of glomeruli and how kidneys filter blood, make sure to get a quick review right now! You might also want a quick reminder about the anatomy for the rest of the kidney, and then you can check yourself by trying to answer the Renal System study guide.)
Nephrosis vs Nephritis: What they have in common
One reason that nephrosis and nephritis can really drive you crazy when you’re reading about them in a textbook because they are actually “syndromes.” This means that they are each diagnosed by a set of common symptoms and findings, and not necessarily the result of a specific bacteria, virus, or other identifiable cause. And of course, since they both involve the kidneys, those common symptoms and findings appear to have a lot of overlap!
First off, the most common forms of both conditions are usually seen in kids, which means that you will most likely be studying them in your Pediatrics class. They both involve a change in the permeability of the glomeruli membrane, resulting in problems filtering the blood. It’s those pesky symptoms that result from blood filtering problems that tend to all look the same at first glance, so now let’s talk about how to differentiate between the nephrosis and nephritis.
Nephrosis – Minimal Change Nephrotic Syndrome
Minimal Change Nephrotic is version of nephrosis most commonly seen in kids. Basically, they’re not even 100% sure what causes it! But it definitely results in a change in the glomeruli membrane’s permeability. So follow this logic…if the glomeruli can’t filter well, then:
- Larger particles, such as protein and blood cells, will be able to “escape” into the urine.
- As the larger particles (particularly the protein and albumin!!) “escape,” oncotic pressure in the blood vessels decreases.
- As the oncotic pressure decreases, fluid will “escape” out of the blood vessels.
- As the fluid “escapes” the blood vessels, the patient develops edema.
Ta-da! If those steps make sense to you, then you have just “memorized” both the causes and the major identifying symptoms of Nephrosis. Don’t believe me? Check these symptoms out:
- Massive proteinuria (protein in the urine) – due to glomeruli permeability changes that allow protein to “escape” into urine
- Hypoalbuminemia (low albumin in blood) – due to loss of albumin, the most common blood protein, into the urine
- Generalized Edema (swelling all over the body) – due to fluid leaving blood vessels as a result of decreased oncotic pressure brought on by the hypoalbuminemia
See how nicely the underlying pathophysiology of Nephrosis explains the 3 major symptoms you can use to identify nephrosis? That’s critical thinking. That’s learning to think like a nurse!
The treatment for Nephrosis is usually pretty low-key. Clients are allowed to continue a normal diet (which I only mention now because it’s a different recommendation than for nephritis treatment!). Then you focus on treating the symptoms. So if there’s a lot of generalized edema, you’re going to take nursing actions that will help preserve their skin integrity. As far as medications go, corticosteriods, especially prednisone, will probably be prescribed to help reduce the proteinuria. If the hypoalbuminemia is severe enough, IV albumin might also be administered.
Nephritis – Acute Post-Infection Glomerulonephritis
Like nephrosis, there are a few different “versions” of nephritis, but the most common is Acute Post-Infection Glomerulonephritis. This also happens to be the most common type of nephritis seen in kids. As the name implies, it tends to occur after another infection somewhere else in the body.
Just like with nephrosis, we can see a logical process to the pathophysiology of Glomerulonephritis, and then relate that process to the resulting symptoms.
- 10-21 days after an infection (especially Strep throat), antibody-antigen complexes (aka White Blood cells attached to dead bacteria) get stuck on the glomeruli walls.
- The body’s immune system activates again to try to clear out the “stuck” antibody-antigen complexes…and the glomeruli walls end up as a casualty of war.
- The immune system attack on the glomeruli causes inflammation (notice the “-itis” part of “nephritis?”), capillary wall damage, both of which result in changes in the glomeruli wall permeability AND the glomeruli becoming even more clogged up.
- As the glomeruli get clogged up, the Glomerular Filtration Rate (GFR) decreases, causing the kidneys to be able to filter less blood.
- When the GFR decreases, the kidneys activate the Renin-Angiotensin-Aldosterone system, which signals the kidneys to increase blood pressure by retaining water and sodium
Now let’s see how we can apply that pathophysiology to the symptoms of glomerulonephritis:
- History of a sore throat – due to a previous Strep infection (this is not always true, but for test-taking purposes it almost always will be!)
- Hematuria, as evidenced by tea-colored urine – due to changes in glomeruli permeability that allows blood cells to escape into urine.
- Hypertension and Oliguria – due to the activation of the Renin-Angiotenson-Aldosterone system, which causes the body to retain fluid (aka make less urine) and retain sodium, both of which cause an increase in the systemic blood pressure.
- Mild edema (often seen as peri-orbital edema) – due to the hypertension and water retention.
One important difference to notice with the edema in glomerulonephritis is that it usually stays pretty mild because the client is not losing as much protein as a nephrotic client loses. So even though the client is retaining a lot of fluid, that fluid is staying inside the blood vessels. Hence, you see hypertension instead.
With Glomerulonephritis, you also need to treat the symptoms until the kidneys are recovered. Sometimes, nephritis can be so mild that it is asymptomatic. But if it is severe enough to cause noticeable symptoms, then the client will usually be put on bed rest. The most dangerous symptom is the hypertension, and that is the one that most interventions will address. For example, the client will probably be put on a sodium restricted diet, and prescribed a diuretic. By trying to decrease sodium and help the kidneys get rid of excess water, hopefully the blood pressure will also decrease. Fluid restrictions are also another common intervention, with fluids being limited to the output from the previous 24-hours plus insensible fluid loses.
Hope that helps clear up the difference between Nephrosis and Nephritis for you…leave a comment to let me know what you think!